The purpose of this paper is to present some of the findings concerning the morbidity rate of monozygotic co-twins of schizophrenics and the possible influence on it of environmental factors. The work is based on a statistical study of the clinical records available at the MRC Psychiatric Genetics Research Unit.

A double-blind trial of special design was used to test the efficacy of imipramine hydrochloride (Tofranil) in low dosage in an outpatient setting over a relatively long period. Depressive patients were given Tofranil and placebo at different times during the trial period, and the improvement and side-effects were assessed.

It is just twenty years ago that I read a paper on the “Problem of Psychogenesis in Mental Disease” before this Society. William McDougall, whose recent death we all deplore, was in the chair. What I then said about psychogenesis could be safely repeated to-day, for it has left no visible traces, or other noticeable consequences, either in text-books or in clinics. Although I hate to repeat myself, it is almost impossible to say something wholly new and different about a subject which has not changed its face in the many years that have gone by. My experience, however, has increased and some of my views have matured, but I could not say that my standpoint has had to undergo any radical change. I am therefore in the somewhat uncomfortable situation of one who, on the one hand, believes that he has a well-founded conviction, but, on the other hand, is afraid to indulge in the habit of repeating old stories. Although psychogenesis has been discussed long ago, it is still a modern, even an ultra-modern, problem.

This paper reports a study of maternal psychiatric illness in school-phobic adolescents admitted to a psychiatric in-patient unit. These cases have been previously described and studied in various ways (Berg, Nichols and Pritchard, 1969; Berg, 1970; Berg and McGuire, 1971; Berg, Butler and McGuire, 1972; Berg and McGuire, 1974).

There have been relatively few studies concerning the occurrence of depersonalization phenomena in normal subjects. Roberts (1960) and Dixon (1963) studied college students and reported a high incidence of brief depersonalization experiences in their samples. The aim of the present study is to investigate the relationship between depersonalization, the conditions under which it occurred and a measure of extraversion/ introversion in a group of normal subjects.

Doctors and mental healthcare professionals are at greater risk of being stalked than the general population, particularly by their patients. Despite causing significant psychological distress, stalking remains underrecognised and poorly managed. Healthcare organisations should ensure appropriate policies are in place to aid awareness and minimise risk, including the provision of formal educational programmes.

Increasing evidence suggests that the concentrations of cyclic guanosine 3′5′-monophosphate (cGMP) in the cerebrospinal fluid (CSF) may reflect central cholinergic activity. When the concentrations of this nucleotide in the CSF from 28 schizophrenic patients (13 without and 15 with neuroleptic treatment) and 16 psychiatrically healthy controls was determined the schizophrenics showed significantly lower CSF levels of cGMP as compared to controls.

As dopamine and homovanillic acid concentrations were not altered in these CSF samples, this finding of reduced cGMP suggests a cholinergic-dopaminergic imbalance in schizophrenia, with a reduction of the former and consequently a relative dominance of the latter.

Somnambulism and the conditions allied to it have always attracted peculiar interest, probably because most men have felt that common sleep, although so familiar, is yet a wondrous and solemn thing, and full of mysterious possibilities for each of us. Cases of somnambulism have naturally lost nothing when reported, the observer and the recorder being alike liable to enhance rather than lessen the mystery. The wholesome scepticism which now prevails as to the truly involuntary character of many nervous disorders was formerly less common. We know that some patients will subject themselves to constant suffering and discomfort, or will practise the most patient and painful imposture, for no conceivable object save to be exceptional or to attract attention; and there is no want of charity in suspecting that in some cases the somnambulism was but hysterical simulation or morbid malingering.

A case of procyclidine abuse is described in which the clinical presentation was indistinguishable from mania. The patient was a long-standing poly-drug abuser and was obtaining the drugs from medical sources. Controlled exposure on the ward to drugs of abuse, including a double-blind comparison with placebo, confirmed that procyclidine caused a manic response in this patient.

Suicide is intentional self-killing, and parasuicide an act of deliberate self-harm—either by injury, ingestion or inhalation—not resulting in death (Black et al, 1982). Both are rare under the age of 12 and the rate of suicide in those under 16 remains consistently low. Referrals to psychiatric services reported by Shaffer (1974) indicated that 7–10% were for threatened or attempted suicide, while Hawton (1982) quoted studies giving the incidence as 10–33% for children aged six to 12; in England and Wales (1962–1968), suicide accounted for 0.6% of deaths in the 10–14 age-range. McClure (1984) found that between 1975 and 1980, only ten such deaths were recorded in the 13-and-under range, and 26 deaths in the 14 year-olds, after which the number of suicides rose sharply with each successive year. That study also showed that parasuicide was most common in the 15–24 age-group, but at younger ages there was a higher proportion of undetermined deaths, as against officially recorded suicides. The social taboos associated with suicide may lead to its systematic under-reporting, but even allowing for that, the phenomenon is still a rare one under the age of 16.

A mentally handicapped man with Cotard's syndrome is described, and the usefulness of electroconvulsive therapy in his management discussed. Even the more uncommon psychiatric syndromes such as this can be found in people with lower intellectual functioning, with clinical features little modified.

Determinations of acid monoamine metabolites, such as homovanillic acid (HVA) and 5-hydroxyindoleacetic acid (5-HIAA), in cerebrospinal fluid (CSF) give valid information on the metabolism of the corresponding amines in the brain tissue (Moir et al., 1970; Roos, 1970). The monoamine metabolites in the CSF are related to age. The concentrations of HVA and 5-HIAA increase with age (Gottfries et al., 1971). Probenecid blocks the elimination of HVA and 5-HIAA from brain tissue to blood (Neff et al., 1964, 1967; Werdinius, 1966) and from CSF to blood (Guldberg et al., 1966; Olsson and Roos, 1968). Probenecid thus normally induces an increase in the concentrations of the acid monoamine metabolites in the CSF, which is related to the turnover of monoamines in the brain tissue.

Eysenck (1952a) has postulated the existence of three main dimensions of personality: Extraversion, Neuroticism and Psychoticism. These are conceived of as independent of each other, and as continuous, with neurotics and psychotics respectively marking the extreme ends of the N and P dimensions. Within each dimension, the particular type of neurotic or psychotic illness is considered to be determined by the degree of extraversion of the patient; thus dysthymic and hysterical disorders mark the introverted and extraverted types of neurotic illness (Eysenck, 1947), while within the psychotic field degree of social withdrawal might be considered to be the variable most closely related to introversion/ extraversion (Venables and Wing, 1962). Hypotheses have also been formulated to account for the causal factors underlying E and N (Eysenck, 1967), although no such hypotheses have been elaborated with respect to P. A special statistical technique (criterion analysis—Eysenck, 1950) has been worked out to test the crucial question of continuity between normal and abnormal (neurotic and psychotic) populations with respect to N and P; application of this method has given support to the theory of continuity (Eysenck, 1950, 1952b).

The outcome in patients receiving long-term in-patient care for manic-depressive psychosis was compared with that in long-stay schizophrenic in-patients and discharged schizophrenic patients. The manic-depressive and schizophrenic in-patients differed in terms of positive and negative features and in the pattern of behaviour, but were equally cognitively impaired. The pattern of behaviour in both schizophrenic groups was the same. The results offer some support for the use of outcome as a validating criterion for the diagnosis of schizophrenia.

Many text-books of psychiatry include an inquiry about a history of nail-biting in their scheme of history taking, and if nail-biting is noted when a patient is examined it is often recorded.